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Levey ST, Goodloe JB, Murphy RF, Van Nortwick S. Mechanical Failure of 2 Cannulated Screw Fixation for Unstable SCFE: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00076. [PMID: 34910713 DOI: 10.2106/jbjs.cc.21.00501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 13-year-old obese boy presented with an acute-on-chronic unstable left slipped capital femoral epiphysis (SCFE). He underwent in situ surgical fixation with two 6.5-mm fully threaded cannulated screws. At 6 months, he presented with mechanical failure of both screws. He underwent screw removal, revision in situ fixation, a peritrochanteric flexion and internal rotational osteotomy, and an open femoroplasty. The osteotomy healed at 6 weeks. The femoral physis took an additional year to close. CONCLUSION This case highlights an uncommon complication of in situ pinning of SCFE, discusses revision fixation options, and suggests possible prolonged physeal closure in severe slips.
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Affiliation(s)
- Sarah Toner Levey
- Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, Indiana
| | - J Brett Goodloe
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, Charleston, South Carolina
| | - Robert F Murphy
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, Charleston, South Carolina
| | - Sara Van Nortwick
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, Charleston, South Carolina
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Kenanidis E, Kakoulidis P, Panagiotidou S, Leonidou A, Lepetsos P, Topalis C, Anagnostis P, Potoupnis M, Tsiridis E. Total hip arthroplasty in patients with slipped capital femoral epiphysis: a systematic analysis of 915 cases. Orthop Rev (Pavia) 2020; 12:8549. [PMID: 33585021 PMCID: PMC7874953 DOI: 10.4081/or.2020.8549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/13/2020] [Indexed: 11/23/2022] Open
Abstract
There is limited evidence on the outcomes of Total Hip Arthroplasty (THA) in Slipped Capital Femoral Epiphysis (SCFE) patients. This systematic review aims to evaluate the current literature in terms of survival rate, functional outcomes, complications and types of implants of THA in SCFE patients. Following the established methodology of PRISMA guidelines, PubMed, Cochrane library, ScienceDirect and Ovid MEDLINE were systematically searched from inception to September 2018. The search criteria used were: (“total hip arthroplasty’’ OR ‘’total hip replacement’’ OR “hip arthroplasty’’ OR ‘’hip replacement’’) AND (‘’slipped capital femoral epiphysis’’ OR ‘’slipped upper femoral epiphysis’’ OR ‘’femoral epiphysis’’). Ten studies were finally included in the analysis and were qualitatively appraised using the Newcastle-Ottawa tool. Variables were reported differently between studies. The sample size varied from 12 to 374 THAs. A total of 877 patients undergone 915 THAs. The mean reported follow-up ranged from 4.4 to 15.2 years and the mean patients’ age at the time of THA from 26 to 50 years. Four studies specified the type of implants used, with 62% being uncemented, 24% hybrid (uncemented cup/cemented stem) and 14% cemented. All but three studies reported the mean survival of implants that ranged from 64.9% to 94.8%. A limited number of complications were mentioned. There was a tendency for more favorable functional outcomes in modern studies. Modern THA-studies in SCFE patients showed improvement of survivorship, clinical outcomes and patient satisfaction. Future higher-quality studies are necessary to estimate long-term postoperative outcomes better.
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | - Panagiotis Kakoulidis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | - Sousana Panagiotidou
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | | | | | - Christos Topalis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | - Panagiotis Anagnostis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | - Michael Potoupnis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Center of Orthopedics and Regenerative Medicine (C.O.RE.) - Center of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University, Thessaloniki, Greece
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Mulon PY, Zarzosa M, Harper DP, Anderson DE. Assessment of two augmentation techniques on the mechanical properties of titanium cannulated bone screws. Am J Vet Res 2020; 81:116-121. [PMID: 31985286 DOI: 10.2460/ajvr.81.2.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effects of 2 augmentation techniques on the mechanical properties of titanium cannulated bone screws. SAMPLE 33 titanium cannulated bone screws (outer diameter, 6.5 mm; guide channel diameter, 3.6 mm). PROCEDURES 11 screws were allocated to each of 3 groups. The guide channel of each screw was filled with polymethyl methacrylate bone cement alone (OCS group) or in combination with a 3.2-mm-diameter orthopedic pin (PCS group) or remained unmodified (control group) before mechanical testing. Each screw underwent a single-cycle 3-point bending test to failure with a monotonic loading rate of 2.5 mm/min. Failure was defined as an acute decrease in resistance to load of ≥ 20% or a bending deformation of 15 mm. Mechanical properties were determined for each screw and compared among the 3 groups. RESULTS All screws in the control and OCS groups and 1 screw in the PCS group broke during testing; a 15-mm bending deformation was achieved for the remaining 10 screws in the PCS group. Maximum load and load at failure differed significantly among the 3 groups. Stiffness and load at yield for the PCS group were significantly greater than those for the control and OCS groups but did not differ between the control and OCS groups. CONCLUSIONS AND CLINICAL RELEVANCE Use of bone cement and an orthopedic pin to fill the guide channel of cannulated screws significantly increased the strength of the construct, but ex vivo and in vivo studies are necessary before this augmentation technique can be recommended for clinical patients.
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Normandin BM, Tennent DJ, Baldini TH, Blanchard AM, Rhodes JT. Mechanical Testing of Epiphysiodesis Screws. Orthopedics 2018; 41:e240-e244. [PMID: 29377054 DOI: 10.3928/01477447-20180123-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/30/2017] [Indexed: 02/03/2023]
Abstract
Epiphysiodesis is performed to treat leg-length discrepancies and angular deformities in children. However, when placed across a physis to modulate growth, screws can bend or break postoperatively. This study evaluated the mechanical properties of 3 different screw designs commonly used when performing an epiphysiodesis. Six 4.0-mm cannulated, fully threaded; six 4.0-mm cannulated, partially threaded; and six 4.0-mm noncannulated, partially threaded cancellous screws underwent cantilever bending and tension testing in a simulated physis. All screws were tested in simulated cancellous bone foam blocks. All testing was performed using a servo-hydraulic testing machine to determine stiffness and ultimate load. For statistical analysis, one-way analysis of variance with Tukey's honestly significant difference test in post hoc analysis was used to assess significant differences among groups (P<.05). The noncannulated, partially threaded screws had a significantly lower stiffness than the 2 cannulated screw types in the tension test (P<.001) and bending test (P<.001). Additionally, the noncannulated, partially threaded screws had significantly higher ultimate load to failure than the 2 cannulated screw types in the tension test (P<.001) and the cannulated, partially threaded screws in the bending test (P=.045). The results indicate that noncannulated, partially threaded screws have a higher ultimate load capacity and are less stiff than both cannulated, partially threaded screws and cannulated, fully threaded screws. Surgeons should take into consideration that noncannulated, partially threaded screws are less likely to fail following epiphysiodesis. [Orthopedics. 2018; 41(2):e240-e244.].
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